scholarly journals Promoting positive maternal, newborn, and child health behaviors through a group-based health education and microfinance program: a prospective matched cohort study in western Kenya

2020 ◽  
Author(s):  
Lauren Yu-Lien Maldonado ◽  
Julia J. Songok ◽  
John W. Snelgrove ◽  
Christian B. Ochieng ◽  
Sheilah Chelagat ◽  
...  
Keyword(s):  
Cohort Study ◽  
Health Education ◽  
Child Health ◽  
Health Behaviors ◽  
Pregnant Women ◽  
Evidence Based ◽  
Matched Cohort ◽  
Western Kenya ◽  
Newborn And Child Health ◽  
And Child Health

Abstract Background: We launched Chamas for Change (Chamas), a group-based health education and microfinance program for pregnant women and their infants, to address inequities contributing to high rates of maternal and neonatal mortality in western Kenya. In this prospective matched cohort study, we evaluated the association between Chamas participation and uptake of evidence-based, maternal, newborn and child health (MNCH) behaviors. Methods: We prospectively compared the uptake of MNCH behaviors between a cohort of Chamas participants and controls matched for age, parity, and prenatal care location. Between October-December 2012, government-sponsored community health volunteers (CHV) recruited pregnant women attending their first antenatal care (ANC) visits at health facilities in Busia County to participate in Chamas . Women enrolled in Chamas agreed to attend bi-monthly group health education and optional microfinance sessions for 12 months. We collected baseline sociodemographic data at study enrollment for each cohort. We used descriptive analyses and adjusted multivariable logistic regression models to compare outcomes across cohorts at 6-12 months postpartum, with α set to 0.05. Results: Compared to controls (n=115), a significantly higher proportion of Chamas participants (n=211) delivered in a facility with a skilled birth attendant (84.4% vs. 50.4%, p<0.001), attended at least four ANC visits (64.0% vs. 37.4%, p<0·001), exclusively breastfed to six months (82.0% vs. 47.0%, p<0·001), and received a CHV home visit within 48 hours postpartum (75.8% vs. 38.3%, p<0·001). In our adjusted models, Chamas participants were nearly five times as likely as controls to deliver in a health facility (OR 5.07, 95% CI 2.74-9.36, p<0.001). Though not statistically significant, Chamas participants experienced a lower proportion of stillbirths (0.9% vs. 5.2%), miscarriages (5.2% vs. 7.8%), infant deaths (2.8% vs. 3.4%), and maternal deaths (0.9% vs. 1.7%) compared to controls. Our sensitivity analyses revealed no significant difference in the odds of facility delivery based on microfinance participation. Conclusions: Chamas participation was associated with increased practice of evidence-based MNCH health behaviors among pregnant women in western Kenya. Our findings demonstrate this program’s potential to achieve population-level MNCH benefits; however, a larger study is needed to validate this observed effect.

scholarly journals Increasing uptake of maternal, newborn, and child health interventions through a group-based health education and microfinance program: a prospective matched cohort study in western Kenya

2019 ◽  
Author(s):  
Lauren Yu-Lien Maldonado ◽  
Julia J. Songok ◽  
John W. Snelgrove ◽  
Christian B. Ochieng ◽  
Sheilah Chelagat ◽  
...  
Keyword(s):  
Cohort Study ◽  
Health Education ◽  
Child Health ◽  
Pregnant Women ◽  
Matched Cohort ◽  
Western Kenya ◽  
Newborn And Child Health ◽  
Matched Cohort Study ◽  
Significant Difference ◽  
And Child Health

Abstract Background We launched Chamas for Change (Chamas), a group-based health education and microfinance program for pregnant women and their infants, to address inequities contributing to high rates of maternal and neonatal mortality in western Kenya. In this prospective matched cohort study, we evaluated Chamas’ impact on improving uptake of evidence-based maternal, newborn and child health (MNCH) interventions. Methods We prospectively compared MNCH intervention uptake between a cohort of Chamas participants and controls matched for age, parity, and prenatal care location. Between October-December 2012, government-sponsored community health volunteers (CHV) recruited pregnant women in Busia county attending their first antenatal care (ANC) visit to participate in Chamas and enroll in this study. Upon joining, women agreed to attend bi-monthly group health education and optional microfinance sessions for 12 months. We selected controls among non-Chamas participants who attended the same ANC clinics. We collected baseline sociodemographic and reproductive health data at study enrollment. We used descriptive analyses and adjusted multivariable logistic regression models to compare outcomes across cohorts at 6-12 months postpartum, with α set to 0.05. Results Compared to controls (n=115), a significantly higher proportion of Chamas participants (n=211) delivered in a facility with a skilled birth attendant (84.4% vs. 50.4%, p<0.001), attended at least four ANC visits (64.0% vs. 37.4%, p<0·001), exclusively breastfed to six months (82.0% vs. 47.0%, p<0·001), and received a CHV home visit within 48 hours postpartum (75.8% vs. 38.3%, p<0·001). In our adjusted models, Chamas participants were nearly five times as likely as controls to deliver in a health facility (OR 5.07, 95% CI 2.74-9.36, p<0.001). Though not statistically significant, Chamas participants experienced fewer stillbirths than non-participants (n=2 vs. n=6, p=0.083). Our sensitivity analyses revealed no significant difference in the odds of facility delivery based on microfinance participation. Conclusions Chamas participation was associated with increased uptake of MNCH interventions among pregnant women in western Kenya. Our findings demonstrate this program’s potential to achieve population-level maternal and infant health benefits; however, a larger study is needed to validate this observed effect.

scholarly journals Promoting positive maternal, newborn, and child health behaviors through a group-based health education and microfinance program: a prospective matched cohort study in western Kenya

2020 ◽  
Author(s):  
Lauren Y. Maldonado ◽  
Julia J. Songok ◽  
John W. Snelgrove ◽  
Christian B. Ochieng ◽  
Sheilah Chelagat ◽  
...  
Keyword(s):  
Cohort Study ◽  
Health Education ◽  
Child Health ◽  
Health Facility ◽  
Standard Of Care ◽  
Matched Cohort ◽  
Western Kenya ◽  
Newborn And Child Health ◽  
Matched Cohort Study ◽  
And Child Health

Abstract Background: Chamas for Change (Chamas) is a group-based health education and microfinance program for pregnant and postpartum women that aims to address inequities contributing to high rates of maternal and infant mortality in rural western Kenya. In this prospective matched cohort study, we evaluated the association between Chamas participation and facility-based delivery. We additionally explored the effect of participation on promoting other positive maternal, newborn and child health (MNCH) behaviors. Methods: We prospectively compared outcomes between a cohort of Chamas participants and controls matched for age, parity, and prenatal care location. Between October-December 2012, government-sponsored community health volunteers (CHV) recruited pregnant women attending their first antenatal care (ANC) visits at rural health facilities in Busia County to participate in Chamas. Women enrolled in Chamas agreed to attend group-based health education and microfinance sessions for one year; controls received the standard of care. We used descriptive analyses, multivariable logistic regression models, and random effect models to compare outcomes across cohorts 12 months following enrollment, with α set to 0.05. Results: Compared to controls (n=115), a significantly higher proportion of Chamas participants (n=211) delivered in a health facility (84.4% vs. 50.4%, p<0.001), attended at least four ANC visits (64.0% vs. 37.4%, p<0·001), exclusively breastfed to six months (82.0% vs. 47.0%, p<0·001), and received a CHV home visit within 48 hours postpartum (75.8% vs. 38.3%, p<0·001). In multivariable models, Chamas participants were over five times as likely as controls to deliver in a health facility (OR 5.49, 95% CI 3.12-9.64, p<0.001). Though not significant, Chamas participants experienced a lower proportion of stillbirths (0.9% vs. 5.2%), miscarriages (5.2% vs. 7.8%), infant deaths (2.8% vs. 3.4%), and maternal deaths (0.9% vs. 1.7%) compared to controls. Conclusions: Chamas participation was associated with increased odds of facility-based delivery compared to the standard of care in rural western Kenya. Larger proportions of program participants also practiced other positive MNCH behaviors. Our findings demonstrate Chamas’ potential to achieve population-level MNCH benefits; however, a larger study is needed to validate this observed effect. Trial Registration: ClinicalTrials.gov, NCT03188250 (retrospectively registered 31 May 2017)

scholarly journals Global Disease Outbreaks and Effects on Maternal, Newborn & Child Health in Global South, a Systematic Review

2020 ◽  
pp. 47-58
Author(s):  
O. Orjingene ◽  
N. L. Akondeng ◽  
A. Kone-Coulibaly ◽  
T. Ogojah ◽  
M. Ganama
Keyword(s):  
Health Care ◽  
Child Health ◽  
Pregnant Women ◽  
Low Income ◽  
Hospital Admissions ◽  
Disease Outbreaks ◽  
Global South ◽  
Hiv Positive ◽  
Newborn And Child Health ◽  
And Child Health

Background/Aim: The world has witnessed several disease outbreaks both in the past and in recent times. Apart from loss of lives as a result of such outbreaks, there are also disruptions in health care provision and utilization due to certain measures aimed at curtailing the spread of such outbreaks. This study aimed to seek evidence from existing literature on the effects of disease outbreaks on maternal, newborn and child health care in Global South. Methods: A Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) was used and 14 literatures met the inclusion criteria. Results: HIV/AIDS pandemic affected the Maternal Newborn and Child Health since increased cases of anaemia, hospital admissions, still births in HIV positive pregnant and cases of foetal anaemia reported in infants born from HIV positive pregnant women were reported. No COVID-19 pandemic related-effects on MNCH observed since no maternal deaths and transmission from infected pregnant women to their newborns reported. Indirect effects of pandemics on MNHC include reduced service delivery and demand/utilization as well as inaccessibility due to diverse reasons. Discussion: The Government should put in place palliative measures for low-income citizens; engage and sensitize women, pregnant women and their children on available health care services and mitigation measures in place to access with minimal or no risk of being infected in a secure environment.

scholarly journals Association between Chinese Dietary Guidelines Compliance Index for Pregnant Women and Risks of Pregnancy Complications in the Tongji Maternal and Child Health Cohort

Nutrients ◽  
2021 ◽  
Vol 13 (3) ◽  
pp. 829
Author(s):  
Ye Ding ◽  
Fangping Xu ◽  
Chunrong Zhong ◽  
Lishu Tong ◽  
Fang Li ◽  
...  
Keyword(s):  
Cohort Study ◽  
Child Health ◽  
Pregnant Women ◽  
Pregnancy Complications ◽  
Gestational Hypertension ◽  
Maternal Diet ◽  
Dietary Guidelines ◽  
Dietary Quality ◽  
Second Trimester ◽  
And Child Health

Background: Compliance with dietary guidelines among pregnant women can positively influence not only their own health but also the health of their babies. Measuring the compliance requires professional skills in nutrition and dietary counseling. In China, few simple and effective techniques assess dietary quality among pregnant women, especially in rural areas. We aimed to establish a new simple and effective assessment technique, the “Chinese Dietary Guidelines Compliance Index for Pregnant Women (CDGCI-PW)” and assess the association between maternal dietary compliance and risks of pregnancy complications. Methods: The CDGCI-PW consists of 13 main components which were based on the 2016 edition of the Chinese dietary guidelines for pregnant women. Each component was assigned a different score range, and the overall score ranged from 0 to 100 points. The Tongji Maternal and Child Health Cohort study (from September 2013 to May 2016) was a prospective cohort study designed to examine maternal dietary and lifestyle effects on the health of pregnant women and their offspring. The maternal diet during the second trimester was compared with the corresponding recommended intake of the Chinese balanced dietary pagoda for pregnant women to verify their compliance with dietary guidelines. The association between maternal dietary quality and risks of pregnancy complications was estimated by regression analysis. Receiver operating characteristic (ROC) curves were constructed to identify the optimal cut-off values of CDGCI-PW for gestational hypertension and gestational diabetes mellitus (GDM). Results: Among the 2708 pregnant women, 1489 were eventually followed up. The mean CDGCI-PW score was 74.1 (standard deviation (SD) 7.5) in the second trimester. The majority of foods showed the following trend: the higher the CDGCI-PW score, the higher the proportion of pregnant women who reported food intake within the recommended range. Moreover, a higher maternal CDGCI-PW score was significantly associated with lower risks of gestational hypertension [odds ratio (OR) (95% confidence interval [(CI): 0.30 (0.20, 0.37)] and GDM [OR (95% CI): 0.38 (0.31, 0.48)]. The optimal CDGCI-PW cut-off value for gestational hypertension was ≥68.5 (sensitivity 82%; specificity: 61%; area under the ROC curve, AUC = 0.743), and the optimal CDGCI-PW cut-off score for GDM was ≥75.5 (sensitivity 43%; specificity: 81%; area under the ROC curve, AUC = 0.714). Conclusions: The CDGCI-PW is a simple and useful technique that assesses maternal diet quality during pregnancy, while adherence to the CDGCI-PW is associated with a lower risk of gestational hypertension and GDM.

scholarly journals Effect and feasibility of district level scale up of maternal, newborn and child health interventions in Pakistan: a quasi-experimental study

BMJ Open ◽  
2020 ◽  
Vol 10 (7) ◽  
pp. e036293
Author(s):  
Zahid Ali Memon ◽  
Shah Muhammad ◽  
Sajid Soofi ◽  
Nimra Khan ◽  
Nadia Akseer ◽  
...  
Keyword(s):  
Child Health ◽  
Scale Up ◽  
Case Fatality ◽  
Population Level ◽  
Evidence Based ◽  
High Burden ◽  
Newborn And Child Health ◽  
The Impact ◽  
And Child Health

IntroductionPakistan has a high burden of maternal, newborn and child morbidity and mortality. Several factors including weak scale-up of evidence-based interventions within the existing health system; lack of community awareness regarding health conditions; and poverty contribute to poor outcomes. Deaths and morbidity are largely preventable if a combination of community and facility-based interventions are rolled out at scale.Methods and analysisUmeed-e-Nau (UeN) (New Hope) project aims is to improve maternal, newborn and child health (MNCH) in eight high-burden districts of Pakistan by scaling up of evidence-based interventions. The project will assess interventions focused on, first, improving the quality of MNCH care at primary level and secondary level. Second, interventions targeting demand generation such as community mobilisation, creating awareness of healthy practices and expanding coverage of outreach services will be evaluated. Third, we will also evaluate interventions targeting the improvement in quality of routine health information and promotion of use of the data for decision-making. Hypothesis of the project is that roll out of evidence-based interventions at scale will lead to at least 20% reduction in perinatal mortality and 30% decrease in diarrhoea and pneumonia case fatality in the target districts whereas two intervention groups will serve as internal controls. Monitoring and evaluation of the programme will be undertaken through conducting periodical population level surveys and quality of care assessments. Descriptive and multivariate analytical methods will be used for assessing the association between different factors, and difference in difference estimates will be used to assess the impact of the intervention on outcomes.Ethics and disseminationThe ethics approval was obtained from the Aga Khan University Ethics Review Committee. The findings of the project will be shared with relevant stakeholders and disseminated through open access peer-reviewed journal articles.Trial registration numberNCT04184544; Pre-results.

scholarly journals “When I Eat Well, I Will Be Healthy, and the Child Will Also Be Healthy”: Maternal Nutrition among HIV-Infected Women Enrolled in a Livelihood Intervention in Western Kenya

2020 ◽  
Vol 4 (4) ◽  
Author(s):  
Annie McDonough ◽  
Sheri D Weiser ◽  
Afkera Daniel ◽  
Elly Weke ◽  
Pauline Wekesa ◽  
...  
Keyword(s):  
Child Health ◽  
Food Insecurity ◽  
Pregnant Women ◽  
Maternal And Child Health ◽  
Maternal Nutrition ◽  
Controlled Trial ◽  
Well Being ◽  
Western Kenya ◽  
Living With Hiv ◽  
And Child Health

ABSTRACT Background Food insecurity remains a major obstacle to achieving health and well-being for individuals living with HIV in western Kenya. Studies have shown that pregnant women are vulnerable to experiencing food insecurity worldwide, with significant consequences for both maternal and child health. The Shamba Maisha cluster randomized controlled trial in western Kenya (which means “farming for life” in Swahili) tested the effects of a multisectoral livelihood intervention consisting of agricultural and finance trainings, farm inputs, and a loan on health and food security among 746 farmers living with HIV in Kisumu, Homa Bay, and Migori Counties. Objectives We conducted a qualitative substudy within the Shamba Maisha trial to understand the experiences and perspectives of pregnant women living with HIV enrolled in the trial. Methods Thirty women who had experienced a pregnancy during the Shamba Maisha study period, comprising 20 women in the intervention arm and 10 women in the control arm, completed in-depth interviews using a semistructured interview guide. Results Intervention participants interviewed noted improvements in maternal nutrition compared with previous pregnancies, which they attributed to the livelihood intervention. Key identified pathways to improved nutrition included improved access to vegetables, increased variety of diet through vegetable sales, and improved nutritional awareness. Women in the intervention arm also perceived increased weight gain compared with prior pregnancies and increased strength and energy throughout pregnancy. Conclusions Livelihood interventions represent a promising solution to alleviate food insecurity for pregnant women in order to improve maternal and child health outcomes. This trial was registered at clinicaltrials.gov as NCT02815579.

scholarly journals Baseline Socio-Demographic and Mortality Profile of a Peri-urban Coastal Community in Karachi, Pakistan Before the Introduction of a Comprehensive Maternal, Newborn and Child Health Intervention Package

2021 ◽  
Author(s):  
Muhammad Ilyas ◽  
Kanwal Nayani ◽  
Ameer Muhammad ◽  
Yasir Shafiq ◽  
Benazir Baloch ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Child Health ◽  
Neonatal Mortality ◽  
Child Mortality ◽  
Mortality Rates ◽  
Evidence Based ◽  
Intervention Package ◽  
Newborn And Child Health ◽  
Live Births ◽  
And Child Health

Abstract Objective Pakistan has the highest neonatal mortality rate and one of the highest under-5 mortality rates in the world, at 42 deaths and 74 deaths per thousand live births respectively. We undertook implementation of an evidence-based maternal, newborn and child health (MNCH) intervention package to reduce under-five mortality in Rehri Goth, a peri-urban coastal community on the outskirts of Karachi, Pakistan. This paper aims to present the socio-demographic and under-5 mortality profile of Rehri Goth prior to implementation of the intervention package. We conducted a detailed census of all households on socio-demographic variables. ResultsOver the course of the census period, 6,962 households were visited. The total population of Rehri Goth was found to be 42,980. The male to female ratio was 52:48. Among adults aged 15 years and above, 67.1% had no formal education. The neonatal mortality and under-five mortality rates were 59 and 109 deaths per 1,000 live births respectively. Rehri Goth has a baseline child mortality rate that is higher than the national average in Pakistan. This provides an opportunity to deliver an evidence-based, targeted MNCH package to reduce child mortality.

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